The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing

Standfield, Lachlan; Comans, Tracy; Raymer, Maree; O’Leary, Shaun; Moretto, Nicole; Scuffham, Paul Anthony

doi:10.1007/s40258-016-0246-1

Cited by 29 publications

(29 citation statements)

References 17 publications

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“…Another noteworthy point of DES for HEE is its allowing for “individual interaction”, which is valuable especially for models involving analyzing the effects of treatment delays due to patient competition for constrained resources [56, 57]. Standffield et al [56] conducted a cost-utility analysis using DES because of the need to consider the impact of introducing OPSC (Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services) on patients queuing time.…”

Section: Discussionmentioning

confidence: 99%

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Application of discrete event simulation in health care: a systematic review

Zhang

2018

BMC Health Serv Res

181

132

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BackgroundThe objective was to explore the current advances and extent of DES (Discrete Event Simulation) applied to assisting with health decision making, as well as to categorize the wide spectrum of health-related topics where DES was applied.MethodsA systematic review was conducted of the literature published over the last two decades. Original research articles were included and reviewed if they concentrated on the topic of DES technique applied to health care management with model frameworks explicitly demonstrated. No restriction regarding the settings of DES application was applied.ResultsA total of 211 papers met the predefined inclusion criteria. The number of publications included increased significantly especially after 2010.101 papers (48%) stated explicitly disease areas targeted, the most frequently modeled of which are related to circulatory system, nervous system and Neoplasm. The DES applications were distributed unevenly into 4 major classes: health and care systems operation (HCSO) (65%), disease progression modeling (DPM) (28%), screening modeling (SM) (5%) and health behavior modeling (HBM) (2%). More than 68% of HCSO by DES were focused on specific problems in individual units. However, more attempts at modeling highly integrated health service systems as well as some new trends were identified.ConclusionsDES technique has been an effective tool to approach a wide variety of health care issues. Among all DES applications in health care, health system operations research occupied the most considerable proportion and increased most significantly. Health Economic Evaluation (HEE) was the second most common topic for DES in health care, but with stable rather than increasing numbers of publications.

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Section: Discussionmentioning

confidence: 99%

“…Standffield et al [56] conducted a cost-utility analysis using DES because of the need to consider the impact of introducing OPSC (Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services) on patients queuing time.…”

Section: Discussionmentioning

confidence: 99%

Application of discrete event simulation in health care: a systematic review

Zhang

2018

BMC Health Serv Res

181

132

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“…Open access management options, but for many of these patients, non-surgical multidisciplinary management is the first line of care. 2 While evidence supports non-surgical interventions such as exercise and weight loss for the management of KOA, [3][4][5][6][7] individual patient responses may vary. It would be clinically and economically advantageous to identify patients with KOA at risk of a poor response to non-surgical multidisciplinary management at the initial consultation.…”

Section: Introductionmentioning

confidence: 99%

“… 8 The service employs experienced musculoskeletal physiotherapists (service leader) to assess and determine management pathways for non-urgent patients within orthopaedic specialist outpatient departments. 2 Where non-surgical management is appropriate, care provided by the service is patient centred with an emphasis on progression from supported to non-supported self-management and is multidisciplinary (as required; physiotherapy, occupational therapy, dietetics and/or psychology) to pragmatically address the mix of biopsychosocial factors potentially underlying each patient’s KOA presentation. 7 9 The retrospective audit showed that patients who reported lower knee function and higher levels of anxiety at their initial appointment within the service were at greater odds of a poor response to non-surgical multidisciplinary management.…”

Section: Introductionmentioning

confidence: 99%

Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

et al. 2020

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ObjectivesTo explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.DesignProspective multisite longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants238 patients with KOA.Primary and secondary outcome measuresStandardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores −7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).ResultsOverall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05).ConclusionsThese characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.

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“…The authors reported that this cost could reduce to AU$29 for a physiotherapist‐led clinic, representing almost a 45% saving in per‐patient cost . Economic modeling has shown that increasing the capacity of a physiotherapist‐led assessment clinic in an orthopedic service would be cost effective, improve patient throughput, and reduce patient waiting times without exceeding available surgical resources .…”

Section: Introductionmentioning

confidence: 99%

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Caffrey

Smart

FitzGerald

2019

ACR Open Rheumatology

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ObjectivePhysiotherapist‐led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist‐led triage in hospital‐based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist‐led rheumatology‐based Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).MethodsA retrospective service evaluation was undertaken of all patients who attended the Rheumatology MAC at St Vincent's University Hospital, Dublin (SVUH) between August 2012 and February 2014. The Clinical Audit Department of SVUH approved the study. Data were analyzed using descriptive statistics.ResultsFive hundred and eight patients attended the MAC: 76% were female and the mean age was 55 years and ranged between 18‐91. Seventy‐five percent of patients were independently managed by the CSP without needing to see a consultant rheumatologist, whereas 17% were referred to the rheumatology team. Eighty‐seven percent of patients referred to the rheumatology team had rheumatological intervention (eg, injection, medical management, or multidisciplinary rehabilitation). A substantially higher proportion of patients with regional musculoskeletal pain and degenerative conditions were independently managed by the CSP compared with those who had rheumatological/inflammatory conditions.ConclusionThe majority of patients who attended the MAC were independently managed by the physiotherapists, suggesting that physiotherapist‐led triage may be a useful and efficient means of managing a proportion of patients referred for a specialist rheumatological consultation.

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The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing

Cited by 29 publications

References 17 publications

Application of discrete event simulation in health care: a systematic review

Application of discrete event simulation in health care: a systematic review

Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

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